Influencing the Policy Making Process: Agenda Setting, Advocacy, Lobbying & Evidence
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1 Influencing the Policy Making Process: Agenda Setting, Advocacy, Lobbying & Evidence Dylan H. Roby, PhD Assistant Professor of Health Policy and Management UCLA Fielding School of Public Health Director of Health Economics and Evaluation Research UCLA Center for Health Policy Research April 12, 2013
2 Understanding the Interaction and Influence of People and Political Institutions: Interests and values, Power to coerce / Power to convince Resources (Human Capital, Political Capital, Money, Reputation) Institutions that channel and structure the use of power to pursue interests, and Personal relationships that are shaped by and cut across institutional structures
3 Types of Policies Old vs. New Existing problem and idea for solution vs. innovation Big vs. Small Comprehensive: values must be agreed upon, adequate knowledge base, correct environment for change, public and elite support (i.e. Medicare/Medicaid) Incremental: interests conflict with other interests; however, a series of incremental changes could have combined power of a major, comprehensive change (i.e. SCHIP, Medicare payment) Substantive vs. Procedural Environmental and Health Policies are often procedural, in order to provide a barrier to prevent unintended or bad consequences
4 The Policy Cycle Issue Raising Often in response to something Policy Design Can occur before or during the issue raising Many ideas have been floating around in public policy circles for years (i.e. Managed Competition or the Individual Mandate) Public Support Building To garner support for the legislation, sponsors must make sure constituents will tell their representative to pass it Legislative Decision making and policy support building The actual debate, campaigning, and passage Legislative Decision making and policy implementation After passage, they must make the new policy reality
5 Reform Occurs When and Where Problem, Policy, and Politics Meet Kingdon s Model of Agenda Setting says: Political Stream Problem Stream Policy Stream Window of Opportunity 5
6 How does this model address the Affordable Care Act (ACA)? What is (are) the problem(s)? What policies were identified to solve them? What political forces were helping the policy to be linked to the problem, and gain public or congressional support? Was the window of opportunity a certainty? 6
7 In the case of the Affordable Care Act, you can see contributing elements: Political Stream Problem Stream Cost and Quality Crises, Economy, Rising Unemployment and Uninsurance Policy Stream Grassroots mobilization, constituents, advocates Window of Opportunity Potential Solutions led by various Policy Entrepreneurs : Health Insurance Exchange, Individual and Employer mandates, the public option, Medicaid expansion, Accountable Care Organizations 7
8 Interest Groups and their Influence on the Policymaking Process 8
9 Specific Types of Interest Groups Professional/Occupation Based American Dental Association California Dental Association Political Action Committees (PAC) Citizen s Groups Grassroots Victim s Organizations Coalitions Corporate Trade Associations (groups of interest groups or corporations) America s Health Insurance Plans (AHIP) PhRMA Pharmaceutical Research and Manufacturing Association
10 Roles of Interest Groups Lobbying Any attempt to influence specific legislation Advocacy Issue Advocacy: promoting a cause, rather than specific legislation Campaign Financing Political Action Committees Citizens United decision allows for corporate expenditures without coordination with candidates (Super PACs) Research Providing evidence for policy positions Computing power makes independent data analysis and collection easier and cheaper Think Tanks and research divisions of advocacy organizations and trade associations Grassroots/Citizen Action
11 Types of Lobbying Grassroots Has the effect of demonstrating public support in order to lay the groundwork for committee votes and ultimate passage Urging general public to call legislators, etc. Often referred to as advocacy Direct Focus on committee, turning supporters into advocates/sponsors Urging members to call legislators, etc. Lobbying for a specific piece of legislation, rather than broader issue
12 What is an interest group s main objective? Is it to get access to legislators so that you can convince them to vote for your interests? 83% of funding went to incumbents on health issues Or, is it to elect officials who will vote for your interests? Will interest group influence via campaign contributions change the make up of the legislative body in your favor? Wilkerson and Carrell (1999 JHPPL) Health care interest groups (i.e. AMA) have different relationship to legislation/voting than others (i.e. NRA, Tobacco). They focus on getting access, rather than one issue AMA has changed their campaign financing strategy substantially since the late 1960s AMA/AMPAC had less impact on actual voting behavior than other interest groups
13 Main goals of Interest Groups Information track voting patterns, provide research to support positions Gaining Access It appears that the actual number of lobbying contracts impacted legislation more than money spend on campaigns Direct Lobbying convert legislator from supporter to advocate or sponsor Target committees Framing Interest groups will frame issues to benefit them Government takeover of health care and Obamacare Simplifying concepts through metaphors Media, Message, and Polling Gauging public support in specific districts Target media markets for specific influential legislators Become a constituent
14 What is Strategic Framing? Framing refers to how messages are encoded with meaning so that they can be efficiently interpreted in relationship to existing beliefs or ideas, (UCLA CCC). Strategic framing is used to shape public dialogue and debate on issues in order to achieve policy goals. According to the Frameworks Institute, public opinion provides politicians with the safe space to initiate policy and forge bipartisan consensus. Unless an issue appears to be on the public agenda, most public officials will not address it. Often public agenda is set by the media
15 The Three Levels of Framing Level 1 expression of overarching values Markets vs. Social Justice Level 2 the general issue being addressed Health Care Equity, the Uninsured, etc. Level 3 the policy detail, tactics or strategy for achieving change
16 Final Thoughts Many opportunities for advocates, lobbyists, and the public to influence the process Legislation Executive Decisions Regulation Initiatives and Referenda The Budget State Battlegrounds Power and Resources can come in many forms Knowing the decision making process and points of attack is very important for advocates and stakeholders Advocates are often the source of policy, acting as policy entrepreneurs to make change
17 Questions? Contact Info: Dylan Roby
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